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Financial Services |
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State Lottery Trust Account Application |
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PLEASE
SEND THE COMPLETED FORM TO THE F & AS RESOURCE MANAGEMENT DEPARTMENT, MAIL DROP 8337 |
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FUND: L481U
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DEPT
ID:
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PROJECT/GRANT:
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DATE: |
| PREPARED BY: |
DEPT:
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EXT/FAX:
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MAIL
DROP:
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| ACCOUNT USE DESCRIPTION: | TO EXPEND LOTTERY FUNDS |
| SOURCE OF REVENUE: | LOTTERY ALLOCATION FROM THE CHANCELLOR'S OFFICE |
| EXPENDITURE CATEGORIES: | ALLOWABLE LOTTERY EXPENDITURES PER CSU GENERAL GUIDELINES |
| THIS ACCOUNT IS TO REMAIN ACTIVE: | INDEFINITELY |
| SHOULD THIS ACCOUNT NO LONGER BE USED, FUNDS WILL REVERT TO THE FOLLOWING: | |
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FUND: L481U
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DEPARTMENT
ID:* 99999
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PROJECT
/ GRANT: DISCRETIONARY
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RESPONSIBLE PERSON: (Individual responsible
for maintaining account solvency). |
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| NAME: | TITLE: |
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| SPECIAL CONDITIONS: | ||
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1. Individuals
(at least two), authorized to approve expenditures or request disbursements from this account. |
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| NAME: | NAME: | ||
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TITLE: |
FINANCIAL MANAGER |
TITLE: |
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| SIGNATURE: _______________________________ | SIGNATURE: _________________________________ | ||
| NAME: | NAME: | ||
| TITLE: | TITLE: | ||
| SIGNATURE: ______________________________ | SIGNATURE: _________________________________ | ||
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DIRECTOR/DEAN APPROVAL: _______________________________________________
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DATE: ________________ |
| THE ADMINISTRATION SERVICE CHARGE OF 2.75% IS NOT LEIVED ON LOTTERY FUNDS. | |
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** Accounting Use Only **
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| TRUST ACCOUNTING APPROVAL: _________________________________________________________ | DATE:_________________ |
| (1/9/2009) | |